Shoulder injury

Advice
#1

Hi i am a 3rd year sports therapy student. I myself do not kayak, however i have a patient with a possible shoulder injury.



I was wondering if anybody could help me?!



The patient i have is 20 a recreational white water kayaker, 2 weeks previously he flipped the kayak upside down when outstretching his left arm to turn himself back around (his arm out straight) he fought against the water and heard a popping sound in the shoulder region.

Following this he had sharp shooting pains down his arm from shoulder to elbow on the outside of his arm. He was unable to lift his arm (abduction) as it felt limp and painful.

He complains of a twinging pain between the shoulder and the elbow, and doesnt appear to have as much stength during paddling.



He originally had normal strength in the arm 2 weeks after when the pain starts to come back again…



Any ideas would be much appreciated.



Thanks in advance

#2

See a doctor
No offense, but it seems that your patient has a messed up shoulder. The position you describe is a classic for dislocation but it sounds like there is residual damage. Needs to have an x-ray and have doc see what is going on.

#3

First, maybe he needs to lay off and
rest that shoulder. I assume he’s taking Aleve or Advil. Second, if the nature of the injury is not clear from manipulation and strength testing, is there a way to wangle an MRI? I know this can be difficult with some insurance requirements. I got a shoulder injury a year ago, and they said I had to do three weeks of physical therapy before they could order an MRI. I said, “How is the PT supposed to know what is safe to do with the shoulder prior to having MRI results?”



Anyway, if I read your inquiry correctly, it’s only a couple of weeks since the injury. That’s not much time for even a minor injury to heal.

#4

see doctor than go from there mri?
by waiting may only could make worth for long term.

#5

Yeah, you’d need a doctor’s order.

#6

Seperated Shoulder?
Might want to check the distal clavacle to see that it is as it should be. Could be a minor seperation (1 deg) that would allow “normal” activity afterwards but pop out again with use. There may be pain at that joint upon pressing it although might not be too bad, a 3-4 on the pain scale. With arm straight out to side at shoulder level, have PT attempt to raise arm against resistance. That may pinpoint the injury through pain.



Let us know what happens.



Tom

#7

He should see a doctor
If his GP doesn’t help, he should see a shoulder specialist or at least a sports medicine doc. They might first take an X-ray (mine did) before recommending PT and possibly an MRI.



I had a similar incident with my shoulder (the arm felt like it popped out of place and then felt like it was dangling). The pain and weakness eventually faded but the shoulder never returned to normal. Both the shoulder doc’s evaluation and the MRI indicated rotator cuff impingement. The PT helped a lot but it just couldn’t get rid of the “catch” in that shoulder, and that side was still weak. To make a long story short, I had surgery more than a year after the initial injury. Now I’m back in PT; hopefully this time I can restore all strength and mobility.


#8

Shoulder injury
Hi guys thanks for your reply i do not feel an MRI is nececessary, however this injury is very puzzling.

examination/palpation

more pronounced scapula on right side (left is the injuried shoulder)

slight scoliosis on cervical spine



On 1st examination:

active movements;

clicking sensation felt on abduction

all fine

passive movements;

a twinge was felt over the middle deltoid fibres on adduction pain scale 4/10.

int/external rot - twinge post deltoid

all over movements fine.



muscle testing:

pain over lateral side middle fibres of deltoid 1/10

beginning range twinge internal rotation

all over movements fine



special tests

empty can - twinge over right lateral aspect of arm




#9

Shoulders can be tough!
I injured my rt shoulder yrs ago and it was a tough nut to crack/no pun intended. Obvious was the separation. Not obvious was the torn rotator cuff. Had constant 7-8/10 pain level. 3 top orthos in Chicago wrote me off as permanently disabled but my Dr wouldn’t give up. Surgery #4 found the torn rotator cuff and repaired it. Been pretty good ever since.



Tom